Idea One. For everything that exists, there is an opposite. Consider that you could readily see different viewpoints on the situation with more than one way to effectively approach, and perhaps solve, the issue. For example, you might engage your wise mind and ask "what am I missing?” Recall a situation where you feel stuck and can now choose to hold the other’s point of view as well as your own. This invites a synthesis that Linehan was pointing toward, and now we are experiencing how change is indeed possible. 

• “Thinking about my relationship with my mother, what I can miss is accepting that what she does is valid in terms of her history. Then her behavior makes sense, I can understand her ways and then I have better choices in how I want to respond.”

​Idea Two. Everything and everyone is connected in some way. Back to our difficult relationship and the possibility that you could understand how each person in the situation is connected to the issue at hand and to each other. From this understanding and recognizing we are “in the same boat,” you might respond to others as you wish they would respond to you. And this usually prompts more care and respect.

• “Think about how your partner is troubled by this conflict, imagine what they may be thinking and feeling, how this weighs on them, how they worry about what to do or say, wondering what might help. Just like you, said my wise friend to me.”

Idea Three. Change is the only constant. We can increasingly recognize how our experience and each person's experience and the situation itself is changing with each moment. With this perspective, you might make an effort to embrace the change that is present, to allow it and not fight it, to more effectively work with the current reality as it is.

• “It's very easy for me to just give up and be hopeless about the way things are, and think this is the way things always will be. But now I see this is me ignoring the truth that things can never stay the same and will always be changing. And honestly, this can be really scary for me too.”

Idea Four. Change is transactional. That change is an unfolding, transactional cycle where each of us reciprocally influences each other. What we do as an impact on our environment and other people in it, just as other people impact us. Here, you might let go of blame and pay more attention to the outcome of my behaviors with an openness to being more effective.

• “I see how my mood affects other people. When I’m cranky or my partner is prickly, we’re just constantly reacting to each other, and then reacting to their reaction.”

Applying these powerful perspectives, we can better understand how we get polarized in key aspects of our closest relationships. Let's get started: Consider when you can get unbalanced and have ineffective responses in the following areas of family life. You may recall specific times when stressful events were leading people into their red zone emotions and polarized, reactive behaviors.

Applying Dialectics to Family Life…
We are going to look at four common areas of family life where behavior can become polarized and lead to ineffective family functioning. When we identify our personal/family challenges, then we can practice our dialectical strategies to move toward balance and synthesis. The following table and discussion is based on the work of Alan Fruzzetti, Perry Hoffman and Charlie Swenson in adapting DBT to support effective family interventions in DBT Family Skills Training, 1999.
​

• Independence vs. Closeness  🠞  Dialectical synthesis in finding a balance between individual autonomy and family connection.

It is not uncommon for some family members to prize independence (perhaps in some aspects of life, yet not all) and other family members to prioritize closeness. Independence to an extreme might lead to painful disconnection and even schisms in the family.  Excessive demands for closeness might produce enmeshment where family members become overly involved in each other's lives and have a hard time expressing their personal needs and limits. Families who support a working balance of autonomy and connection tend to be healthier.

• Structure vs. Flexibility  🠞  Dialectical synthesis in establishing routines while allowing for spontaneity.

Structure can support stability in family life, reliable routines, and consistently caring relationships that foster safety in our relationships.  Flexibility helps us to navigate life’s changes and have healthy continuity. At the extreme, structure can becomes excessively rigid or controlling. Unbounded flexibility or an absence of basic structure becomes chaotic, unpredictable, and potentially unsafe.

• Responsiveness: Under- vs. Over-Responsiveness  🠞  Dialectical synthesis in navigating stress effectively without becoming overly reactive or passive.

How do we cope with stress? Are we able to respond to it effectively? The extremes can lead us to over-reaction on one pole or to non-responding on the other pole. This could be understood as extremes of the acceptance/change dialectic: accepting to the point of complete passivity/surrender or having an excessive change focus that is hyper-active to the point of exhaustion/destruction.
​

• Communication: Dysregulated vs. Avoidance  🠞  ​Dialectical synthesis in effectively expressing thoughts and emotions while also respecting limits and regulating emotions.

How do we effectively communicate our emotional awareness and what we're thinking? We know from DBT, that a balanced state of mind that holds both the knowledge of our emotion mind and reasonable mind is possible. And beneficial. We also know we can become dysregulated in our emotions or hijacked by excessive conceptualizing and intellectualizing to the point we can become avoidant of our experience, and cut off from the insights of our emotions, our body, our intuition, our wise mind.
​
Personal/Family Challenge: We are going to overlay these four areas of family life with the four ideas of dialectics discussed at the beginning. 

• Identify which of these areas of your family life manifest struggles with problematic extreme behaviors. 
• Next let’s explore which of the four perspectives of dialectics can support you so you can replace the conditioned, reactive behaviors with skillful, goal-directed behaviors to build more balance. 

​These dialectical ways of thinking are vastly different from how many of us were raised. At times in our past, the main question might have been “what is wrong?” or perhaps “who was wrong?, which is a long way from a dialectical approach of “what am I missing?” or “together, how can we understand our different needs? 
How do we hold both acceptance of ourselves and of our family members or friends? For example, when one of us needs structure to cope with the demands of relocating or just taking a vacation, while the other needs flexibility. How do we make room for change that supports a loved one to take some independent initiative and also respect our value of family connectedness? What changes do we need to make and what changes do they need to make? 
There is never one answer, yet fortunately we have some powerful allies in our dialectical perspectives.

PRACTICE - How are you going to use these dialectics to work more effectively with your chosen, challenging family interactions?

• Choose one of the four dialectical perspectives (multiple viewpoints, connectedness, changing reality, change is transactional/reciprocal) 
• AND one of the four areas of family behaviors (interdependence, flexibility, stress tolerance, communication). 
• Apply these perspectives to several relevant life situations and then look for how you can use additional DBT skills, such as to create a “Cope Ahead” or “DEAR MAN” plan.
• Evaluate what worked and what needs troubleshooting.

​Let us know how it goes!

—

References:
Linehan, MM. (2014). DBT skills training handouts and worksheets. New York. Guilford Publications.
Linehan, MM. (2020). Building a life worth living. New York: Random House.
Hoffman PD, Fruzzetti AE, Swenson CR (1999). Dialectical behavior therapy-family skills training, Family Process, 38, 399-414.

​Perhaps it’s the tension in your jaw or the sinking feeling in your belly that is grabbing your attention. Perhaps, you are recognizing the signs of your dinosaur brain pulling you toward flight or fight. You may have a pretty good idea of the likely outcomes of acting on that urge to angrily protect yourself or to exit in a state of panic. Can you recall such a time in the not so distant past? In those times we may need to take a break, to push the pause button, to take a few minutes to reset. This is even more important when we are feeling agitated with those we deeply care about. These are times when we might effectively use timeouts to skillfully retreat and then proceed in a way that can work.  
As Alan Fruzzetti, author of The High-Conflict Couple: A Dialectical Behavior Therapy Guide to Finding Peace, Intimacy, and Validation, recommends: If your arousal is very high, take a break and work to bring it down before you initiate the conversation…You will be glad you took the extra few minutes to self-regulate and get balanced before moving ahead.

Purpose of Timeout: Take a break. Stop what you are doing for a designated time, so you can cultivate mindful awareness, regulate emotions, and prepare to effectively engage.  *This is not to escape or avoid an issue, a person or an unpleasant emotion.

How to Take an Effective Timeout in 3 Steps

• Step 1.  Recognize the escalating tension or arousal of negative emotion. Mindfully notice if you are heading into the red zone of emotion dysregulation. Propose to take a timeout from the interaction to reduce the intensity of agitation to a more workable level. If the agreed time allotted for a timeout may not fit, propose an alternative for when you can discuss the issue further. 
• Step 2.  Remain apart for the designated amount of time. Use the time to de-escalate, calm and regulate your emotions; cultivate mindfulness; take responsibility for your ineffective behavior and prepare to effectively engage your loved one. Breathe 3x. Clarify what your primary emotion is. Consider how you can express this directly and effectively. Consider how you can validate your partner.
• Step 3.  Return at the agreed time. If the other person or you need additional time, negotiate this or reschedule a time to return to the conversation. Otherwise, begin by stating what you wish to validate in your partner’s experience and what of your behavior you are willing to change to be more effective. In turn, each of you actively listen to what your partner expresses and again respond in validating ways.
• After years of living in North Carolina (and Indiana before that), I am “required” to use a basketball analogy. Please feel free to substitute a different sport that uses some variation of timeout (modified versions in baseball, volleyball, cricket, football, ice hockey). Even the 25 seconds allotted to serve in tennis is enough time for several mindful breaths!

 
Here is my basketball analogy of 3 steps for an effective timeout (DBT skills in italics). When UNC and Duke engage in their classic basketball rivalry, Coach Williams and Coach K will mindfully observe their players during the game. At Step 1, when either team is not effectively executing the game plan, a coach can call a 75 or 30 second timeout. Each team has agreed to this as part of the rules of the game. Note: Both agree to temporarily stop play and one team does not continue play without the other. Neither team is quitting or avoiding playing the game.
  
Step 2. Each team gathers or “huddles” with their coach who describes the problem (analysis) and suggests solutions to get in synch with the flow of the game. The coaches don’t spend this time berating the other team, rather the focus is on what works. The players become more focused (one-mindful) and calmer (soothing distressed emotion mind). They leave the huddle more organized to effectively participate based on their game plan and goals (value = play to the best of their ability). 

Step 3. At the agreed time, each team returns to the court to resume the game. The teams come back. While they may choose to take another timeout, they do not hop on the bus to return to Chapel Hill or Durham. The teams return to the court with a renewed effort to effectively perform, rather than to prove the other team is somehow wrong. Each team aims to do what works.
 
When we began, I asked you to recall a time when you were about to ineffectively react to a difficult situation prompting you to fight or to flee. Would taking a timeout be useful for you in similar situations? Take a look again at the 3 steps. Consider how you would initiate a timeout, how you would effectively use the time to regulate the intense emotion or urge, and lastly, how you would return and what you would do to promote an outcome more fitting with your goals. DBT offers many helpful skills to increase our mindful awareness, to soothe our heightened arousal, and to initiate more effective behaviors that can replace harmful impulses. See the related blog on Navigating Emotional Obstacles for ideas. To put these steps of effective timeouts into action, here’s a worksheet you can use to create a personal strategy that can work. 
 
May your teamwork triumph!
 
For more information on upcoming DBT Family Skills Training workshops, please contact John Mader, LMFT, DBT-Linehan Board of Certification, Certified Clinician™ at jmaderlmft@gmail.com.
Next: A Morning for Interpersonal Effectiveness, August 25, 2018 and
A Morning for Emotion Regulation and Distress Tolerance, September 29, 2018.

​We know that we can respond to conflict situations more constructively when we are not in the heat of the emotion or becoming emotionally dysregulated. Who among us is at our best when we are lost in reactive anger, fear, or shame referred to as "the red zone?" These moments can be challenging even if we have gained a solid set of relationship skills. In the May 2018 issue of Lion’s Roar magazine, the American Buddhist nun and teacher, Pema Chodron, offers practical methods for staying regulated or "holding your seat" when these interpersonal challenges arise. In our DBT (Dialectical Behavior Therapy) skills group, we used her suggestions as the basis for a mindfulness exercise on responding to conflict. One of the goals for the Interpersonal Effectiveness Skills is to handle conflict situations more effectively. You might think of the exercise that follows as an application of the skill, Cope Ahead (see Emotion Regulation Handout 19).

We began with bringing our attention to our sensations of sitting in the chair, noticing the light from the late-afternoon sun and breathing. Then, we brought to mind a recent interpersonal situation or person that we found to be difficult. We affirmed our intention to use skills to be more effective in the face of provocation, as Pema Chodron writes “holding your seat...without giving in to reactivity or unskillful anger.” Or as we say in DBT, we are going to practice ways to “surf the urge.”

The first method is to not set up the target for the arrow..."that is to say that each time you retaliate with words and actions that hurt, you are strengthening the habit of anger. Then, without doubt, plenty of arrows will always be coming your way.” Pema Chodron offers us a choice. “Each time you sit still with the restlessness and heat of anger--neither acting it out nor repressing it--you are tamed and strengthened.” We can mindfully observe the emotion, we can name it, and we can use skills to change, accept, or solve the situation. The other choice is to act on the urge of anger or suppress it, however then we (unintentionally) become a walking target and reinforce the problem behavior. She further suggests that we can ever so gradually shape our behavior to be more effective and fitting our values. “Understand that if you hold your seat even for 1.5 seconds longer than ever before, you are starting to dissolve a pattern of reactivity that, if you let it, will continue to hurt you and others forever.”

• Visualize yourself holding your seat, not providing a target for the arrow of anger, refraining from acting on the urge while sitting with the restless discomfort...for 1.5 seconds longer. See yourself shifting this pattern of reactivity if only for a little longer that allows you to respond more effectively than in the past.

The second method is to connect with your heart. Pema Chodron describes, “In times of anger, you can contact the kindness and compassion that you already have. When someone harms you, you can understand that they are sowing the seeds of their own misery...The life of one who is always angry is painful, and generally very lonely.” So, again we sit with our restless discomfort and anger without acting on it. Neither are we pushing it away. We connect with our heart and hold the anger. The compassion of our "wise mind" is bigger than the anger. We gently, firmly hold the anger and open to becoming stronger, kinder.

• Visualize yourself doing so in the same situation you have recalled. Breathe with your experience of anger. Not getting lost in the anger. Not making it go away. Breathing in kindness for yourself. Breathing out kindness to this one who is so angry, in so much pain and misery and likely quite lonely.​

​
The third method is to see obstacles as teachers. I picture Pema Chodron wryly smiling with this instruction. “If there is no teacher around to give you direct personal guidance on how to stop causing harm, never fear! Life itself will provide the opportunities for learning how to hold your seat. The troublemaker, for instance, who so disturbs you—without this person how could you ever get the chance to practice patience? How could you ever get the chance to know the energy of anger so intimately that it loses its power?” When you are about to go off and unceremoniously crash into the red zone, consider that, in this very moment, you are being taught how to sit with this intensely uncomfortable, restless energy. What if, as Pema says, you are “being challenged by the teacher to hold your seat and open to the situation with as much courage and as much kindness as you possibly can?”

• For our last visualization, see yourself responding to your difficult person from your "wise mind." This is an opportunity to refrain from acting out of "emotion mind." This is a call to muster the courage to be skillful instead of reactive. This is a challenge to take this difficult situation/person as an opportunity to express your skills and kindness. And notice what you experience in all five senses in your body, how you breathe, and how you move to kindly engage this person as you “hold your seat.”

Group members voluntarily shared the method they would practice during the week. They agreed to make this an experiment we would review in the next class. Several people were particularly drawn to the possibility that they try might view their difficult person as an opportunity to practice their DBT skills. One commented on how this was a great way to practice radical acceptance. Another saw how viewing this (difficult) person as a teacher involved the skillful use of "opposite action." Others saw value in being reminded to refrain from acting on old urges that inevitably lead to more conflict, or more arrows drawn to the magnetizing target of their anger. Connecting with our heart was seen as a high bar for one to actually meet anger with kindness, yet several members felt encouraged to become more skillful in accessing their compassion. These three methods underscore the importance of “effective compassion” which DBT's originator, Marsha Linehan, emphasized is essential for us to transform suffering and create lives worth living.

Which method do you choose to practice this week? 

 John Mader, 2018,  jmaderlmft@gmail.com  ​

Here’s a summary of our experts’ (DBT Grads) recommendations for navigating through the red zone.

·       Recognizing that we are in the red zone.  

·       Change body experience or awareness.

·       Re-direct attention to an ally or valued actions.

·       Take a break from the situation.

·       Mindfully observe and describe emotion.

·       Recall “we are doing the best we can.”

·       Talk with someone you are close to who can really listen.

·       Validate and be validated. 

John Mader, 2014,  jmaderlmft@gmail.com  

The Four Basic Assumptions  
 (DBT-Family Skills Training, Perry Hoffman, 1999, 2003)

1.    There is no one truth or any absolute truth, but usually two or more truths.

2.    Everyone is doing the best they can.

3.    Everyone needs to try harder.

4.    Interpret situations in the most benign way possible.

“Well, you never…” 

“If you really cared, then…”

“You are so wrong…” 

How many times have we said things that assumed we were right, that we knew what the other person was really feeling, thinking or doing, or when we were utterly convinced that the “worst case scenario” would occur? And what was the result of holding and expressing these negative assumptions? These are probably not our proudest moments or our most effective interactions!

In my work with families coping with life's difficulties and challenges that can surely test all of us at times, I have found that embracing this set of four assumptions can be quite beneficial. These particular “working assumptions for relationships that matter” have provided a useful framework to move loved ones toward more effective relating. Perhaps, these can be useful to you in more effectively engaging friends and family during periods of stressful change. These are guidelines or touchstones for you to experiment with, rather than a list of moral pronouncements or rigid commands. This is offered with the hope that you might benefit as others have. The purpose of intentionally holding these basic assumptions is quite practical; the purpose is to communicate more effectively and to genuinely connect with those we care about. 

The first of these four “working assumptions” is “there is no one truth.” In any group of people, there are many perspectives. Each of us has a unique experience--a unique perspective or vantage based on our life history, our state of mind, our level of understanding, our hopes and wishes, and our habitual patterns and life lessons. No ordinary human being has a corner on the market for the truth. So, there is not only one right way of seeing and understanding and acting in a particular moment. This notion encourages us to engage in nonjudgmental mindfulness of each other, to cultivate some curiosity about how others perceive a situation, and  to willingly take an open stance with a more expansive, inclusive view. 

The second basic assumption is “all of us are doing the best we can.” Of the four assumptions, this one tends to evoke the most skeptical reaction. Please remember that this not intended to be a philosophical argument on who is right and who is wrong. Of course, one could argue exceptions to this assumption that one is doing the best she can when its clear that mistakes are being made. The purpose again is to remember that the people we care about are not malicious--that they are doing what they think is best at that moment and in that situation for themselves or even others. They may be genuinely heeding some important value or priority. Perhaps they are coping the best they can with escalating and painful emotions. You yourself are doing the best you can at this moment, with what you know, with your current abilities, with the resources that you have. This assumption encourages us to engage each other with patience and compassion, rather than reactive judgment. 

The third basic assumption provides a welcome dialectic or some balance to the second assumption. While each of us is doing the best we can, “we can each try harder” in the sense that we can learn to become more skillful, and we can gain more knowledge. We can redouble our efforts to practice patience, empathy and validation. This assumption balances the fundamental attitude of acceptance with the essential willingness to change such that our relationships can improve and deepen. 

 And the last of our basic or working assumptions is founded on the fact that we care about each other and that the well-being of each of us truly matters. So, we do our best to “interpret each situation in the most benign way possible.” Basically, we give each other (and ourselves) the benefit of the doubt. We refrain from the urge to assume the worst. We witness our minds producing plentiful negative thoughts and conclusions, and we refrain from immediately acting on these. This is not to deny negative aspects of reality, however we are intentionally investigating a more benign interpretation and genuinely considering this perspective. Then, we can mindfully consider the pros and cons of taking those actions or expressing those thoughts. This assumption can be a very powerful way of transforming a not uncommon predicament--when we are holding a fixed, limited, and negative view of someone we currently feel estranged from and yet really do care about. From this benign stance, we can take actions that fit with our values and gradually become more of the kind of friend or family member we want to be.

Here's a practice suggestion. Choose one of these four basic assumptions to bring to mind during the next day or two. Notice how and when this helps you to use your DBT skills more effectively and to continue building the relationships that make life worth living.

John

John Mader, MA, LMFT  |  AAMFT Approved Supervisor  |  AAMFT Clinical Fellow  |  Co-Director, TADBiT 
919.968.0231 x. 2  |  jmaderlmft@gmail.com  |  www.dbtfamilyskills.com  |  triangleareadbt.com